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General NPI Number Information
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NPI Number | 1114403128
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Entity Type | Organization
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Legal Business Name | TOP OF THE WORLD RANCH MILAN-LLC
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Dates
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Enumeration Date | 07/12/2018
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Last Update Date | 12/23/2019
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Provider Practice Location Address
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Address Line | 3333 155TH AVE
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City | MILAN
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State | IL
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Zip | 61264-7607
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Country | US
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Telephone | 309-623-4510
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Fax |
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Provider Business Mailing Address
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Address Line | 3333 155TH AVE
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City | MILAN
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State | IL
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Zip | 61264-7607
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Country | US
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Telephone | 309-623-4510
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. MARK SADLER
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Credential |
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Telephone | 844-814-8885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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